Orthopedic Diagnostic Tests

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Handouts/Brochure

Speaker

Paul Langlois, APN, PhD, CCRN, CCNS Related seminars and products

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Paul Langlois, APN, PhD, CCRN, CCNS, is a critical care clinical specialist in the surgical, medical, neurologic, burn, CCU, and trauma ICUs of Cook County Hospital, Chicago. Drawing on over 40 years of experience assessing and managing patients with life-threatening diseases, Dr. Langlois provides advanced-level training to nurses, physician assistants, nurse practitioners, respiratory therapists, and physicians.

Dr. Langlois is committed to providing the highest quality of care to patients through advanced education. His presentations are evidence-based, timely, and provide participants with numerous case studies to facilitate critical thinking. As a bedside clinical nurse specialist, he has developed several institution-wide protocols for the multidisciplinary assessment and management of infectious disease and multi-system organ failure patients.

His presentations are enthusiastically delivered and offer highly practical tips that help make the most challenging concepts easy to understand. Linking knowledge to clinical practice is the goal of every educational program.  

 

Speaker Disclosures:
Financial: Dr. Paul Langlois has employment relationship with Cook County Hospital and Emergency Care Consultants. He receives a speaking honorarium and recording royalties from PESI, Inc. He has no relevant financial relationships with ineligible organizations.
Non-financial: Dr. Paul Langlois is a member of the American Nurses Association, the American Association of Critical Care Nurses, and the Society of Critical Care Medicine.

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Objectives

1. Determine five key factors when performing an orthopedic physical assessment. 
2. Analyze the appropriateness of non-invasive tests to be performed based on the patient’s presentation for the following: Cervical spine pain, thoracolumbar pain, painful joints (shoulder, elbow, wrist, knee, hip and ankle). 
3. Evaluate presentations that would require a clinician to order radiographic tests (x-ray, CT, MRI, fluoroscopy, bone scan, myelography) versus non-radiographic tests (ultrasound, electrodiagnostic/EMG)) for bone and joint pain. 

Outline

Conducting an Orthopedic History and Physical Assessment 

• Medication classes that affect orthopedic history and assessment 
• Clinicians can do better than the acronym AMPLE (allergies, medications, past medical history, last eaten, events leading to symptoms) in history taking  
• The two most missed assessments on your orthopedic patient 
• Pain: Differentiate between point tenderness versus nerve transmission  
• Distinguishing features of bone, nerve, joint and soft tissue damage or inflammation 
• Is RICE (rest, ice, compression and elevation) enough or are further tests warranted? 

Physiotherapy Tests and Maneuvers Which Can be Performed in the Outpatient Setting 

• Cervical radiculopathy versus a neck muscle strain 
• Shoulder instability and dislocation – perform this non-invasive procedure 
• Diagnosing lateral epicondylitis in your patient without x-rays 
• Is this carpal tunnel, arthritis or tendonitis?   
• How to diagnose the most common injury of the knee without radiation 
• Lumbar radiculopathy: Is it disc herniation or something else  
• Strategies to differentiate Achilles tendon rupture or Aspergilloma – they may present similarly  

Cervical Spine Maladies 

• Does this patient warrant a radiograph, CT or MRI? 
• When should contrast be used for the CT and MRI? 
• Four must-consider factors before imaging the cervical spine 
• Situations that require a radiographic odontoid view on your patient 

Thoracic and Lumbar Spine Injuries 

• Always get an MRI when the patient’s history and assessment reveal this finding 
• When is the axial or sagittal view best for diagnosis 
• Determine when a myelogram should be ordered on your patient 

Stress Fractures 

• Bedside ultrasound is all that may be warranted for a diagnosis 
• When is bone scan, CT or MRI needed? 
• Frequent fractures: Bone mineral density scan can provide the diagnosis with T- and Z- scores 

Painful Joints 

• Fluoroscopy is better than CT or MRI when the patient presents with these findings 
• Physical exam suggests carpal tunnel syndrome; when to get electrodiagnostic testing (electromyography, EMG) 

Case studies